Significant Survival Improvement in Recipients with Lupus Nephritis on Kidney Transplantation: Single Center Experience

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Abstract

Objectives

To examine the incidence for recurrent lupus nephritis, allograft loss, and survival among systemic lupus erythematosus (SLE) kidney transplant patients comparing before and after year of 2000.

Methods

The retrospective corhort of all SLE kidney transplant recipients in this institution from June 1989 to June 2016 were reviewed. Patients under 18 yrs. old were excluded. Time-to-event (above outcomes) was examined by Kaplan Meier method and Wilcoxon analysis.

Results

Nearly 800 renal transplantations were performed in this institution, 16 SLE recipients were identified. All recipients except one were female transplanted at age of 34.6±10.1yrs. old. 8 patients transplanted before 2000, and rest of 8 patients transplanted after 2000. All 16 but one recipients have no recurrence of lupus nephritis by protocol biopsy. Just one recipient had recurrent lupus nephritis (WHO III) without graft dysfunction. Before 2000, 4pts were died from 1 for cancer, 1 for severe liver disease, and 2 for infection, 50% of mortality was noted. After 2000, all 8 recipients have survived, however 1 for hepatic cancer, 1 for pancreatic cancer, 1 for cellebelar infarction, one for systemic amyloidosis and 1 for chronic rejection. No recipients failed graft except death with functioning graft. 5 recipients married and 3 having baby among them.

Conclusion

While recurrent lupus nephritis is known around only 10%, mortality is rather high in 20% especially in African American ethnicity. This retrospective Asian analysis was found to be less mortality after a year of 2000. Contemporary immunosuppression (introduction of MMF, tacrolimus, basiliximab and reduced dosage of steroid) might lead to favorable outcome. SLE patients have already suffered from taking so much dose of steroid before transplant, such like young female patients should be cared with caution at minimum dose of immunosuppression.

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